Since we will be welcoming in a new year tonight I thought that it would be interesting to review a few healthcare stories from last year.
Interestingly enough our fine President Donald Trump made his prediction for the coming year. He is predicting that Democrats and Republicans will “eventually come together “on a new health care plan for the country. I’m not sure that I believe that prediction!
Sending a Twitter post early Tuesday from his Florida resort, Trump said: “the very unfair and unpopular Individual Mandate has been terminated as part of our Tax Cut Bill, which essentially Repeals (over time) Obamacare.”
Much of former President Barack Obama’s Affordable Care Act remains intact, however, and the sign-up period for the various options was carried out as normal this year.
Majority Republicans sought repeatedly to repeal the 2010 law this year, but couldn’t get it through the Senate.
American healthcare went on a roller-coaster ride in 2017. It was a year marked by tremendous change, potential disruption, and stunted progress, with familiar headlines running alongside startling new revelations.
President Trump declared the nation’s opioid epidemic a “public health emergency” in October, two months after a top pharmaceutical CEO stepped down from the president’s American Manufacturing Council. A rash of shootings sparked renewed debate about mental health reform while, across the pond, a British-born infant with a rare genetic disease was placed in the center of a heated debate about parents’ rights.
One could make a solid case for any of these stories, or dozens of others, as the top healthcare headline of the year. The following three were selected for their social, political and business impact in 2017, and for their potential to drive important health care changes in the future.
Merger Mania Goes Vertical
The year began with the impending merger of several large U.S. health plans. The “big five” – covering an estimated 90% of all commercially insured Americans – entered 2017 with the potential to become the even-bigger three.
Anthem was poised to acquire Cigna. Aetna, meanwhile, was on track to take over Humana. With purchase deals in place, all that remained was regulatory approval from DOJ.
This particular hurdle, however, proved too tall for insurers. Citing the risk of “drastically constricting competition” in a number of key markets, then-Attorney General Loretta Lynch sued all four merger hopefuls in 2016. The insurers’ underlying merger strategy, the DOJ argued, was a clear attempt to increase market power. The courts upheld that view.
By May, both deals were dead. Aetna and Anthem were on the hook for billions of dollars in financial penalties and additional damages. Come summertime, merger mania appeared to be yesterday’s news.
However, talks of new mega-deals emerged early this month.
This time, vertical integration took center stage, led by pharmacy giant CVS, which proposed the $69 billion purchase of the nation’s No. 3 health insurer Aetna.
CVS officials claim the buyout will lead to cheaper drug prices for consumers, along with greater operational efficiencies for the business. Experts note the deal could also disintermediate major parts of the delivery system, drawing patients out of local emergency rooms and into CVS’s lower-priced retail clinics, especially during times when most doctors’ offices are closed.
UnitedHealth Group, the nation’s largest insurer, announced its second multi-billion dollar acquisition of the year in December. After buying Surgical Care Affiliates for about $2.3 billion in March, United recently entered into a $5 billion agreement to acquire DaVita’s primary and urgent care network. The latest move would give United more control over the care-delivery process, especially among DaVita’s 1.7 million members.
Merger rumors swirled once again this month with talks of Walmart possibly purchasing Humana, eyeing access to the insurer’s extensive Medicare Advantage membership. And although not a healthcare company yet, Amazon’s acquisition of Whole Foods may be the online retailer’s first big step toward a play in the pharmacy space.
Despite Trump’s executive order in October declaring, “My administration will … continue to focus on promoting competition in health care markets and limiting excessive consolidation throughout the healthcare system,” most prognosticators are betting the more vertically oriented deals will go through, with only slight concessions required from these industry giants.
Political Intrigue Rises From The Ashes
The Republican party entered 2017 with control of the U.S. House, Senate, and the presidency – marking the first majority sweep by either party since 2009-2010, the same era that ushered in President Obama’s signature healthcare legislation.
With the shock of the 2016 presidential election dominating headlines early in the year, Trump looked to make good on campaign promises by urging Congress to repeal and replace the Affordable Care Act.
In May, the House narrowly passed The American Health Care Act of 2017, despite estimates from the CBO that 23 million Americans would lose their health insurance within a decade.
As the debate moved to the Senate floor in June, many elected officials who campaigned against the ACA learned a difficult lesson. That is, it’s easy to engage voters on Obamacare’s failings but hard to sell them on legislation that takes their health coverage away.
Without a meaningful “replacement” plan, the GOP’s attempts to undo Obamacare stalled out in the wee hours of July 28 when Republican Senator John McCain delivered a decisive thumbs-down vote.
Having failed three times to pass a bill in Congress, most people and pundits assumed federal healthcare reform would need to wait until 2018.
But like the phoenix rising from the ashes, the GOP tax plan was brought to vote in December, passing by a narrow margin in the Senate. The bill included a provision to repeal the “individual mandate,” the law requiring individuals to have an ACA-compliant insurance plan or pay a financial penalty.
Although nearly two-thirds of American voters opposed the tax plan, Republicans moved quickly to push the bill through conference committee. Having lost a Senate seat in the reliably red state of Alabama last week, the GOP found itself with an even slimmer margin for error. Rather than letting the process drag on into January, when Democrat Doug Jones is expected to be sworn in as Alabama’s newest U.S. Senator, the bill is expected to reach the president’s desk for signature as early as this week.
By eliminating the individual mandate, the CBO estimates that 13 million Americans will lose their health coverage, thus saving the federal government $338 billion over the next decade. Only time will tell if either projection proves accurate.
Sexual Misconduct Exposed
In 2017, the Silence Breakers were named TIME Magazine’s “Person of the Year” for their willingness to shine a light on a problem long kept hidden in the shadows.
Fueled by actors Rose McGowan and Ashley Judd, who came forward with allegations of sexual assault and harassment against Harvey Weinstein, the #metoo movement gained nationwide attention.
Other disturbing reports surfaced throughout 2017, detailing the exploitation of power by politicians, businessmen, media members and cultural icons. Each new revelation required courage from the individuals who stepped forward, many of which faced threats of threats of retaliation and legal action.
Bringing these stories into the public domain has proven important for many reasons. Among them are the health consequences of this type of harassment and abuse. The link between interpersonal abuse and public health has been well validated.
Victims of sexual assault, as well as those who suffer intimate partner violence (IPV) and adverse childhood events (ACEs), frequently experience severe anxiety, depression and chronic illness. What’s more, health issues resulting from trauma are known to negatively impact not just the victims, but often their children and grandchildren, as well. Complicating matters further is that people who suffer abuse rarely get the treatment they need, often due to feelings of shame, fear or self-blame.
Although the disclosure and public acknowledgment of abuse cannot fully reverse the harm inflicted on the victims, removing the stigma of speaking out can encourage more people to step forward and, importantly, seek help.
Ultimately, by providing assistance to those impacted, we can help prevent future abuses and improve the overall health of our nation.
We should expect more revelations to surface in 2018.
A Great question has raised its ugly head, after Individual Mandate Repeal, Who’ll Pay for Rising in Uncompensated Care after millions are expected to drop insurance coverage? Jack O’Brien of HealthLeaders Media, noted that the passage of the Republican tax reform bill included a provision to remove the individual mandate penalty, a key aspect of the Affordable Care Act, also known as “Obamacare,” which will have a significant impact on how hospitals care for more uninsured patients.
The bill did not repeal the individual mandate but gutted the penalty for Americans without insurance, which is 2017 was either a $695 fine or 2.5% of income, whichever amount was greater.
The decision is expected to increase the uninsured population by four million in 2019, according to a Congressional Budget Office (CBO) report released last month. The number of uninsured Americans is expected to rise by 13 million by 2027 as young adults drop out of the market without the mandate penalty.
With a higher uninsured rate, health system leaders must now address how to care for a larger population lacking insurance coverage. The long-planned reduction of federal payments to disproportionate share hospitals (DSHs) poses an additional challenge.
Currently, the Centers for Medicare & Medicaid Services (CMS) administers payments to DSHs, which predominantly tend to low-income patients including those without insurance. The Urban Institute estimates that the federal government covers 35% of uncompensated care costs, the total amount of healthcare provided with no payment received.
Federal DSH Spending Rises with Uninsured Rates
The funding formula for both Medicaid and Medicare DSH payments is based in part on a state’s uninsured rate. The Medicaid DSH formula specifically relies on how well the state directs payments to hospitals with high volumes of Medicaid inpatient utilization, and how well the state directs payments to hospitals with high levels of uncompensated care.
Federal DSH spending totaled $12 billion during the fiscal year 2016, according to information from the Kaiser Family Foundation (KFF). The CBO in its November analysis estimated that a $44 billion increase in DSH payments would be needed over the next decade due to the individual mandate repeal.
Since automatic increases in DSH spending are based on higher uninsured rates, the burden of uncompensated care will be partially offset by the increase in the amount of money a hospital receives, Matthew Fiedler, Ph.D., a fellow with the Center for Health Policy in the Brookings Institute’s Economic Studies Program, told HealthLeaders Media in an interview. “The uninsured rate will have a direct effect on the amount of uncompensated care and an indirect effect on the amount of DSH payments that are made, in Medicare at least, because the uninsured rate is part of the formula that determines how much DSH payments any given hospital is entitled to.”
DSH Funding on 8-Year Reduction Plan
In the original text of the ACA, federal funding reductions were planned for DSH payments to coincide with an expected decrease in the uninsured rate nationwide. The reductions were set to go into effect in the fiscal year 2014 and last through the fiscal year 2020, but legislation was passed in 2013 to postpone them until the fiscal year 2018.
Despite the 4-year layoff, nearly two-thirds of states did not sufficiently allocate their FY 2018 budgets for the scheduled reductions, according to KFF. In July, CMS proposed a rule that ordered the beginning of reductions with $2 billion in FY 2018.
The current DSH reductions are projected to run through the fiscal year 2025, totaling $43 billion.
The potential impact of changes to the DSH program on hospitals is unclear until Acting Secretary of Health and Human Services Eric Hargan makes cuts or redistributions of DSH allotments, said David Mosley, managing director with Navigant Healthcare in Atlanta.
The impact will depend on the cost of people who utilized services without payment compared with the number of people who will be uninsured and eligible for DSH, Mosley said.
“I would love to have some wonderful prognostication,” he said, “but the answer is there are a few variables out there that, until someone tells us the value of those variables, we don’t know.”
An Entire OR team Kneels During Time Out Protocol to Protest Administrators!
And on a funny note- in a stunning turn of events, entire OR teams including Anesthesia kneeled today during all surgical timeouts today at Bellin Hospital. The shocking display of unity against the hospital administrators has sharply divided the medical community across the globe.
The impetus of the mass genuflection was a lone General Surgeon, Dr. Bessie Jandle, who refused to comply with the mandate from Joint Commission that all OR staff wear bouffant scrub caps. Jandle started kneeling during timeouts in protest over a year ago, but no one paid much attention to it even after his contract with Bellin Health was not renewed.
This summer, several other isolated surgeons started kneeling during their own timeouts, which caught the attention of Bellin Health hospital administrator Timofy Weeber MPH, MHA, GED, POS. Weeber demanded that all departments fire any and all surgeons who refused to stand for timeouts. Weeber’s demands, which he didn’t have the authority, ability or spine to enforce, actually served to galvanize and unite the entirety of the OR staff.
In OR 2, every person in the OR including the patient dropped down to a knee arms interlinked for the timeout. Numerous other OR’s had similar happenings with 75% of all OR teams dropping to a knee or sitting down for the timeout. When word started to spread of the protests, several anesthesiologists claimed that they have been sitting down during timeouts and even entire cases for years.
Meanwhile, in OR 4, Ortho also took a knee and replaced it with a better one.
Happy New Year to All! May you all! Enjoy a Wonderful New Year! Words to guide us all in 2018: Gratitude, Kindness, Love, Honesty, Empathy, and Forgiveness!